Needs of relatives of breast cancer patients: the perspectives of families and nurses.

PURPOSE: Breast cancer is not only a stressful event for those afflicted, but also for their family and friends. In Germany, attention and support from professional nurses is almost exclusively given to the patient. But even relatives require information and support in order to keep their anxiety levels low and strength up. The aim of this study is to survey those needs and the current level of satisfaction, as well as to ascertain which needs are perceived by nurses. METHOD: Data were collected in a German-wide descriptive cross-sectional study surveying 242 relatives and 356 nurses from 150 randomly chosen certified breast care centers between August 2008 and February 2009. Two questionnaires developed for this study were used. RESULTS: The findings indicate that relatives need above all a) security and trust, followed by b) partnership of care and c) emotional support. Regarding satisfaction, relatives consider the need for "security and trust" to be most satisfied. Least fulfilled were those for "partnership of care" and "emotional support". The nurses regarded the importance of most of the relatives' needs to be higher than the relatives themselves. Even the fulfillment of needs was over-estimated. CONCLUSIONS: The targeted and professional involvement of relatives in the care of breast cancer patients is still not common practice. An initial step toward better family nursing is viewing families as an integral part of the patient and intentionally planning contact.

Stress and nursing care needs of women with breast cancer during primary treatment: a qualitative study.

PURPOSE: The primary surgical therapy for breast cancer represents a special phase in the course of the disease. The aim of this study was to find out the specific strains influencing the women affected during this time, and the needs and expectations they had of the nurses. METHOD: In a semistructured interview, 42 women at an early stage of breast cancer were asked about their strains and care needs. RESULTS: The results show that the women interviewed suffer more from psychological strains than physical ones, and express the wish for, above all, emotional support. Analysis of the interviews provides 4 categories of strains: immediate strains regarding the surgery, fear through uncertainty, change of self-perception and the strains caused by the social environment. Care needs can be divided into 3 main areas: wishes for (a) the relationship to the nurses, (b) professional competence and (c) the external conditions of care. CONCLUSIONS: Nurses can support the women well by listening to them, accepting their emotions and informing them in detail. Therewith, they can convey a sense of security to the women and help them to maintain hope and the ability to deal with reality.

[Self-rating and external rating of how women cope with breast cancer in the perioperative phase]. / Coping bei Frauen mit Brustkrebs im perioperativen Bereich - Selbst- und Fremdeinschätzung.

Little is known both about how women suffering from breast cancer cope with their illness in the perioperative phase and about the ability of nurses to assess this. By means of the self-rating and external rating versions respectively of the Bernese Coping Modes (BEFO), it was determined how breast cancer patients cope with their illness during primary surgical therapy. External rating was carried out by the nurses and two researchers. The nurses' rating based on their daily care experiences, and the researcher's rating based on a half-standardized interview. Participants were given the BEFO self-rating questionnaire. As with the patients themselves, the nurses and team members rated attention and care (H(A) 90,5-100%), tackling (H(A) 66,7-100%), passive co-operation (H(A) 59,5-100%) and acceptance/stoicism (H(A) 64,3-97,6%) as the strongest forms of coping. In ranking order of coping modes the researchers rated dissimulation and isolation/suppression and the nurses rated altruism much higher than the patients themselves. Several forms of coping revealed a clear dependence on age. The discrepancy between the ranking order of the nurses' rating versions and the patients' self-ratings were discussed on the basis of empirical findings on communication events between nurses and patients.

[Qualitative investigation into the strain endured by breast cancer patients in initial in-patient therapy]. / Qualitative Untersuchung zu Belastungen von Brustkrebspatientinnen in stationärer Ersttherapie.

In-patient hospital stays and primary breast cancer operations put a strain on the affected women, about which little is known to date. In order to gain a better understanding of this stress situation, 42 primary operated breast cancer patients were surveyed in qualitative interviews during their in-patient hospital stay. Besides suffering from existential anxieties and uncertainties, typical stresses for the perioperative area are the fear of the anaesthesia and operation, the uncertainty felt while waiting for the histological findings, the first change of dressing and the fitting of a prothesis as well as post-operative physical ailments. The area of psychological strain by far exceeds that of physical strain. For this reason, professional care in the perioperative senological area should include the qualified psychosocial support of the affected women, in addition to their classic physical care.

[The needs of breast cancer patients for nursing support during initial stationary treatment]. / Bedürfnisse von Brustkrebspatientinnen nach pflegerischer Unterstützung während der stationären Erstbehandlung.

The aim of this study is to explore the subjective care needs, specially directed at nurses, of women with breast cancer during primary surgical therapy. Investigations have revealed that psychosocial support of affected women can have a positive effect on how they cope with the disease and on the course of the disease. Guideline-aided qualitative interviews with 42 affected women were conducted for the study. Data analysis was performed according to the criteria of an embracing content analysis. The needs of those women interviewed concern three levels: the emotional level encompassing the aspects of nurturance, emotional support and communication in line with patients' needs, the problem level, in which reliable and professionelly correct care is important, and the organisational level, which stands for a patient-friendly organisational culture. Patients' expectations and needs toward nurses are varied, encompassing a wide spectrum of professional nursing care.

[Burden and coping strategies of women suffering from breast cancer during their surgical primary therapy--the view of nurses]. / Belastungen und Bewältigungsstrategien von Frauen mit Brustkrebs in der Phase der chirurgischen Primärtherapie--die Sicht der Pflegenden.

The findings illustrated in this article, are part of a larger research project funded/financed by the Deutsche Krebshilfe e.V., with the aim of gaining understanding of the stresses and strains, coping strategies and needs of women suffering from breast cancer during their surgical primary treatment. Breast cancer leads to a variety of burden for women and their families. To cope with the disease women use different strategies. External assessment and self-assessment of burden and coping sometimes result in different outcomes, such as experts overestimating their patients' fear or depression or uncovering coping strategies oblivious to the interviewees. Qualitative interviews with twelve nurses in three Northern German hospitals were conducted. The content analysis of the interviews followed Mayring's approach. Uncertainty and anxiety are common characteristics for the affected women. The observed strategies can be classified into five categories: to deny the disease, to withdraw from others, to communicate, to comprehend the disease, to accept the disease. Coping strategies such as withdrawal and denial present a challenge to the nurses' communication behaviour. The findings of the survey at hand indicate a demand for suitable care interventions, further education, and training for professionals nursing women with breast cancer. Scientifically supported nursing concepts and specialised nurses are expected to comply with the affected women's special requirements.